title: Diaphragmatic nerve palsy after cardiac surgery in children in Egypt: outcome and debate in management.
abstract: BACKGROUND
  Diaphragmatic paralysis (DP) due to phrenic nerve injury is a complication which occurs in association with congenital cardiac surgery and may be a life-threatening event in infants and young children. Information about this complication is still scarce from the developing countries.
  
  
  METHODS
  Retrospective study evaluated the incidence of DP among 414 patients who underwent congenital cardiac surgery in Abo Elriesh Children's Specialized Hospital, Cairo University, Egypt, in the duration from April 2009 to December 2011.
  
  
  RESULTS
  Incidence of DP was 3.6% (15 of 414 cases). Median age of affected patients was 10 months (ranged from 1 month to 13 years). Diagnosis of DP was observed after ventricular septal defect repair (3.9%), Glenn anastomosis (8.6%), Tetralogy of Fallot repair (4.3%), Senning operation (10%), arterial switch operation (3.2%), Fontan procedure (33%), coarctation of the aorta repair (7%), and pulmonary artery banding (6.4%). Diaphragmatic plication was performed in 4 of 15 cases. Patients with DP had significantly prolonged mechanical ventilation duration as compared to unaffected patients (median 120, range 48-600 vs 4, range 0-48 hours, P < .000). They also had a higher incidence of nosocomial pneumonia in 8 of 15 (53%) cases, longer duration of intensive care unit stay (median 15, range 4-62 days, P < .006), and significant mortality in 7 of 15 (46%; P < .004). Mortality among patients who underwent diaphragm plication was 1 of 4 (25%).
  
  
  CONCLUSIONS
  Diaphragmatic paralysis is a relatively rare complication of congenital cardiac surgery in children. Its occurrence is associated with increased morbidity and mortality. A high index of clinical suspicion, utilization of bedside diagnostic tools, and a policy of early plication for certain patients may lead to improved outcomes.
authors.affiliation: Department of Pediatrics, Cairo University, Cairo, Egypt. amiraesmat@yahoo.com
authors.forename: Amira Esmat
authors.initials: AE
authors.lastname: El Tantawy
authors.forename: Soha
authors.initials: S
authors.lastname: Imam
authors.forename: Hisham
authors.initials: H
authors.lastname: Shawky
authors.forename: Tarek
authors.initials: T
authors.lastname: Salah
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000601:surgery; D004534:Egypt; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D010791:Phrenic Nerve / Q000293:injuries*; D012133:Respiratory Paralysis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies
keywords: complications; diaphragm; echocardiography; infant; intensive care; surgery